By Richard Boyd
It seems that we are endlessly measuring things in pharmacy. Business figures (such as daily prescription counts and annual sales) must be measured to assess performance. Patient health figures (such as blood pressure and glucose levels) must be measured much for the same reasons. Only by measuring are we able to assess a baseline value, and from there we can strive for improvement. So why shouldn’t this concept hold true for patient medication adherence?
There are many ways that medication adherence can be measured. Patient medication diaries, pill counting, refill rates, and simply asking the patient are all valid methods. Typically once an adherence issue is recognized, the patient is alerted and told to “get back on track” (typically in more professional, empathetic terms!). Instead of constantly taking the “eat your vegetables!” approach to improving adherence, however, some pharmacists may choose to step back and let the patient assess themselves.
A number of medication adherence surveys have been developed that can be quickly and easily administered in the community pharmacy setting. These surveys have been validated in multiple disease states, and are a great way to get patients to think about their own behavior. No guidelines currently exist as to which survey is best, but each has its own benefits. The major surveys of interest to the community pharmacist include the Medication Adherence Questionnaire (MAQ), the Self-efficacy for Appropriate Medication Use Scale (SEAMS), and the Brief Medication Questionnaire (BMQ).
The survey validated in the broadest range of disease states (including hypertension, dyslipidemia, HIV, Parkinson’s disease, type 2 diabetes, heart failure, and coronary artery disease) is the MAQ. This survey is only four items long, consists of simple yes or no questions, and has been shown to consistently detect non-adherence at the point of care. The SEAMS (validated in chronic disease states including coronary artery disease, hypertension, dyslipidemia, and diabetes) and BMQ (used in patients with diabetes, depression, and other chronic diseases) are 13 and 9 items long (respectively), and attempt to gauge other barriers to medication adherence. However, both of these scales are difficult to score at the point of care.
Given national averages that put medication adherence at 50–60 percent, patient surveys are yet another useful tool in the pharmacist’s arsenal of improving patient care. The MAQ is the briefest, easiest to score, and most widely validated survey, although there are advantages of using other surveys in various patient populations. Given the type of patient and the time available, an appropriate survey can be selected and discussed with the patient at the point of care. Give it a try and see if you can make a difference in your patient’s adherence.
Medication Adherence Questionnaire (MAQ) (Morisky, et al. 1986)
1. Do you ever forget to take your medicine?
❑ Yes ❑ No
2. Are you careless at times about taking your medicine?
❑ Yes ❑ No
3. When you feel better do you sometimes stop taking your medicine?
❑ Yes ❑ No
4. Sometimes if you feel worse when you take the medicine, you stop taking it?
❑ Yes ❑ No
Reprinted with permission from National Community Pharmacists Association in the June 2011 issue of America’s Pharmacist. For more information about NCPA, visit www.ncpanet.org.